Citation NR: 9622432
Decision Date: 08/08/96 Archive Date: 08/16/96
DOCKET NO. 94-27 274 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Boston,
Massachusetts
THE ISSUE
Entitlement to an increased evaluation for service connected
anxiety disorder, currently rated 30 percent disabling.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
The veteran
ATTORNEY FOR THE BOARD
J. R. Bryant, Associate Counsel
INTRODUCTION
The veteran served on active duty from August 1971 to
December 1972.
This matter is before the Board of Veterans’ Appeals (Board)
of the Department of Veterans Affairs (VA) on appeal from a
rating determination of June 1992, by the Boston,
Massachusetts, Regional Office (RO) which denied an
evaluation in excess of 30 percent for service-connected
anxiety disorder.
REMAND
The veteran contends that his anxiety disorder symptoms are
worse than the assigned evaluation of 30 percent reflects.
He complains of anxiety, an inability to relax, sleeping
difficulties, poor concentration, limited interpersonal
relationships and an inability to hold any job. A letter
from a VA physician dated in April 1992 indicated the veteran
continued with supportive therapy for anxiety disorder and
that he seemed to have periods of depression resulting from
severe anxiety levels, insecurity and poor self-esteem,
affecting his daily life functioning, resulting in his being
unable even to help on the family farm. The examiner related
the veteran had been unable to obtain gainful employment at
the present time and due to his inadaptability to any
environment, complicated by severe dependency, any gainful
employment whether by himself or in a structured situation,
remained a poor prognosis. The examiner declared the veteran
unemployable in the foreseeable future.
At a VA examination conducted in June 1992 the veteran
complained of, among other symptoms, tension and chronic
anxiety, palpitations and jitteriness, apprehension,
depression with crying spells, stuttering, distrust of
others, hyperalertness, low self-esteem, flashbacks,
difficulty with concentration and relationships. The 1992
examination report documents that the veteran underwent a
thyroidectomy for cancer in 1978 and additional surgery in
1979 for removal of lymph nodes from the neck area and was
seen every few months for follow-up care. The examiner noted
the veteran’s history of surgery made it almost impossible
for him to pass pre-employment examinations and his anxiety
condition added to the difficulties he experienced. He was
able to work part-time for his brother but only on a limited
schedule. The veteran was considered competent but
unemployable. The diagnoses was generalized anxiety disorder
and major depression.
Based on the 1992 examination, the rating board denied an
increased rating for anxiety disorder on the basis that the
veteran’s symptoms were not productive of more than definite
social and industrial impairment. The statement of the case
further stated that the evidence showed that the veteran
could work part-time and that a substantial part of his
industrial impairment was due to his nonservice connected
status post thyroidectomy.
Clinical records dated from November 1987 to September 1993
show regular treatment at the Mental Hygiene Clinic since
1991. In March 1992 the veteran underwent a comprehensive
psychological assessment. The overall impression was of a
schizoid personality with anxious and dependent features.
A second VA examination was conducted in September 1993.
There was no clinical evidence of acute psychosis,
hallucinations, paranoia or delusions but a marked anxiety
mood was evident. The diagnoses were general anxiety
disorder, rule out dysthymic disorder on Axis I and mixed
personality disorder, not otherwise specified on Axis II.
The veteran’s Global Assessment of Functioning (GAF) Scale
score was 50. At a personal hearing conducted that same
month, the veteran testified that he was struggling to
maintain his current marriage as well as a part-time job at
the post office, for which he had worked periodically for
about seven years. He further testified that he went to a VA
medical center for treatment two to three times a month.
The Board is not free to exercise its own judgment as to the
extent to which the veteran’s status post thyroidectomy
constitutes an impediment to securing or maintaining gainful
employment and is precluded, in fact, from exercising an
opinion on any medical matter. Colvin v. Derwinski, 1
Vet.App. 171 (1991). The Board finds that the veteran should
be examined to differentiate social and industrial impairment
resulting from the service connected and the non-service
connected disorders.
In connection with the development requested herein, the RO
is required to make a determination with respect to the
veteran’s potential entitlement to a total rating based on
individual unemployability under 38 C.F.R. §§ 3.340, 3.341,
4.16 (1995).
Accordingly, in view of the foregoing the appeal is REMANDED
for the following actions:
1. The RO should obtain all additional
VA or private medical records dated from
September 1993 to the present, pertaining
to psychiatric symptomatology and
treatment of the veteran. Copies of
complete clinical records should be
associated with the claims folder.
2. The veteran should undergo both
general medical and psychiatric
examinations to ascertain the severity
and extent of his nonservice-connected
status post thyroidectomy and to
determine the current severity of his
service-connected anxiety disorder. All
indicated tests and studies should be
conducted and all findings should be
reported in detail. On the basis of both
current examination findings and a
thorough review of all records in the
claims file, the appropriate examiner
should identify the extent to which the
veteran’s status post thyroidectomy
constitutes an impediment to securing or
maintaining gainful employment. The
reasoning behind the conclusions should
be stated in full. The appropriate
examiner should also offer an opinion as
to the veteran’s GAF Scale score and
include an explanation of the numerical
GAF score, as it pertains to social and
industrial impairment due solely to the
service-connected anxiety disorder. The
claims file should be made available to
the examiners for review in the study of
the case.
3. After the development requested above
has been completed, the RO should again
review the record, to include
consideration of the raised issue of
entitlement to a total rating based on
individual unemployability. If the
benefit sought on appeal remains denied,
the veteran and his representative should
be furnished a supplemental statement of
the case and given the opportunity to
respond thereto.
Thereafter, the case should be returned to the Board, if in
order. The Board intimates no opinion as to the ultimate
outcome of this case. The veteran need take no action unless
otherwise notified.
BARBARA B. COPELAND
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1995).
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